We report the distribution and imaging of calcium andaluminum in neurofibrillary tangle (NFT)-bea... more We report the distribution and imaging of calcium andaluminum in neurofibrillary tangle (NFT)-bear-ing neurons within Sommer's sector of the hippocampus in Guamanian patients with parkinsonism-dementia, using a method of computer-controlled electron beam x-ray micro- analysis and wavelengthdispersivespectrometry. Calciumand aluminum weredistributed in cell bodiesandaxonalprocesses ofNFT-bearing neurons.Theelemental images showthatboth calcium and aluminum deposits occur within the same NFT-bearing hippocampal neuron in this dementing disease, sug-gesting thattheseelementsareinvolved in NFTformation. No prominentconcentrations ofcalcium andaluminumwereim- aged in non-NFT-containingregions withinthe pyramidal cell layer ofthe parkinsonism-dementia casesorinthecontrolcas-es. These findings support the hypothesis that secondaryhyperparathyroidism resulting fromlow environmental calci-umand magnesium inthe high-incidence focus ofamyotrophic lateral sclerosis andparkinsonism-dementia
Background: Many cases of dementia with Lewy bodies (DLB) present with various psychotic features... more Background: Many cases of dementia with Lewy bodies (DLB) present with various psychotic features, including hallucinations, depression, catatonia, and delusions before the onset of cognitive impairment. However, the characteristic features of these psychotic symptoms in prodromal DLB have not been sufficiently described. Objective: To clarify and describe the psychotic features of prodromal DLB before overt cognitive impairment. Methods: The authors analyzed the characteristic psychotic features of prodromal DLB in 21 subjects who developed severe psychotic symptoms without dementia and were diagnosed as DLB after the longitudinal observation period. They were then confirmed to have DLB through indicative and supportive biomarkers of scintigraphy. Results: The psychotic features included a wide variety of symptoms, but convergent to three principal categories: catatonia, delusions-hallucinations, and depression and/or mania. Catatonia was observed in nine cases, five were delusiona...
Dear Editor, There are gender differences in the initial symptoms of dementia with Lewy bodies (D... more Dear Editor, There are gender differences in the initial symptoms of dementia with Lewy bodies (DLB) and the symptoms when the diagnosis is confirmed, with females having been found to frequently exhibit more psychotic symptoms such as visual/auditory hallucinations, delusions, and depression compared to males. Meanwhile, the frequency of rapid eye movement sleep behaviour disorder is significantly higher in males. Fujishiro et al. sent a letter to us, offering an overview of the possibility that gender differences in incidence of DLB may affect these results, and they included a review of the literature, such as clinical and pathology reports, highlighting that consensus has not been reached regarding the gender differences in DLB incidence. It is easy to assume DLB if visual hallucinations are observed as a psychotic symptom at the onset of DLB, but if the initial symptoms of DLB are other psychotic symptoms such as auditory hallucinations, depression, or delusions, the patient may be more readily diagnosed with other psychotic disorders such as late onset schizophrenia (LOS), senile delusions, and senile depression, rather than DLB. DLB has hypersensitivity to antipsychotic medicines, and drug therapy may have a risk of side effects in some cases. The results of our study indicated that the frequency of auditory hallucinations as the initial symptoms and at the time of diagnosis is higher in females than in males, which is consistent with that of the Tsunoda study. The International Late Onset Schizophrenia Group has taken the unified view that very late onset schizophrenia-like psychosis (VLOSLP), which develops after age 60, predominantly affects females and is mainly characterised by hallucinatory-delusional state or delusional states. It is possible that DLB has some involvement in VLOSLP because the pathological reports related to LOS or VLOSLP actually included DLB cases. In addition, depression has a high prevalence among middle-aged and elderly women, and depressive symptoms frequently appear in the prodromal stage of DLB. Accordingly, careful observation is necessary to distinguish this condition from DLB. There have been numerous research reports published in recent years concerning the prodromal stage of DLB. It has become clear that psychotic symptoms such as visual hallucinations, auditory hallucinations, delusions, and depression appear in conjunction with the prodromal stage of DLB. The presentation of various psychotic symptoms prior to the appearance of neurological findings and cognitive impairment in DLB cases is thought to be due in part to the diversity of the patterns of Lewy body development. The DLB pathology report published by Fujimi et al. states that the neocortical type was significantly more common in females (54.0%) than in males (18.1%), which could explain why females exhibit more psychotic symptoms than males. The existence of gender differences in symptom incidence of DLB, including the stage of prodromal DLB, is certainly an important aspect to consider in order to ensure accurate clinical diagnoses of DLB and to promote understanding of the pathophysiology of the prodromal stage in the future.
Although dementia with Lewy bodies (DLB) is characterized by a variety of initial symptoms, there... more Although dementia with Lewy bodies (DLB) is characterized by a variety of initial symptoms, there are almost no reports of the initial symptoms of DLB assessed in a large number of cases. We retrospectively evaluated the initial symptoms of 234 participants with DLB and DLB‐related symptoms at diagnosis and characterized any gender differences in the symptom profiles.
In Alzheimer’s disease, apart from inscription memory deficit, other high order brain function de... more In Alzheimer’s disease, apart from inscription memory deficit, other high order brain function deficits also appear in the early stage, such as geographical orientation deficit, visual cognition deficit, and organization deficit. These neuropsychological symptoms are rarely seen in other dementiform diseases and are considered to be characteristic of Alzheimer’s disease(AD).4 Among these, organization deficit including constructional disability almost inevitably occur in AD. As this deficit is considered to be closely related to the visual space cognition deficit, we analyzed the visual information processing mechanism for the execution of organization, using newly developed methods such as a vision analyzer.1 The results showed a characteristic fixation movement in AD patients. A concentration of fixation points on the right hand side, and concentration and deviation of the fixation points when the patients observed copied and original figures, were frequently seen, when the patient was copying a geometrical figure.
Neurofibrillary tangles (NFT) are one of the most prominent pathological changes seen in the brai... more Neurofibrillary tangles (NFT) are one of the most prominent pathological changes seen in the brains of Alzheimer’s disease (Alz) patients. Under the electron microscope these NFT are revealed to be composed of accumulations of paired helical filaments (PHF). These structures are also observed in Parkinsonism-dementia complex of Guam (PD), and some other diseases besides Alz.
Amyloid deposits occur in the forms of senile plaques (SP’s), amyloid angiopathy(AA), and plaque-... more Amyloid deposits occur in the forms of senile plaques (SP’s), amyloid angiopathy(AA), and plaque-like vascular changes in the brains of Alzheimer’s disease (Alz) patients. These pathological changes are important since the occurrence of these structures is correlated with the severity of the dementia. A protein consisting of 42–43 amino acids and with a molecular weight of about 4000 kd, designated as amyloid A41 or β-protein,2 has been isolated as a component of amyloid protein (Am) from AA in the Alz brain. The same A4 protein as in AA is also found commonly in various types of SP’s in Alz and Down’s syndrome.
We report the distribution and imaging of calcium andaluminum in neurofibrillary tangle (NFT)-bea... more We report the distribution and imaging of calcium andaluminum in neurofibrillary tangle (NFT)-bear-ing neurons within Sommer's sector of the hippocampus in Guamanian patients with parkinsonism-dementia, using a method of computer-controlled electron beam x-ray micro- analysis and wavelengthdispersivespectrometry. Calciumand aluminum weredistributed in cell bodiesandaxonalprocesses ofNFT-bearing neurons.Theelemental images showthatboth calcium and aluminum deposits occur within the same NFT-bearing hippocampal neuron in this dementing disease, sug-gesting thattheseelementsareinvolved in NFTformation. No prominentconcentrations ofcalcium andaluminumwereim- aged in non-NFT-containingregions withinthe pyramidal cell layer ofthe parkinsonism-dementia casesorinthecontrolcas-es. These findings support the hypothesis that secondaryhyperparathyroidism resulting fromlow environmental calci-umand magnesium inthe high-incidence focus ofamyotrophic lateral sclerosis andparkinsonism-dementia
Background: Many cases of dementia with Lewy bodies (DLB) present with various psychotic features... more Background: Many cases of dementia with Lewy bodies (DLB) present with various psychotic features, including hallucinations, depression, catatonia, and delusions before the onset of cognitive impairment. However, the characteristic features of these psychotic symptoms in prodromal DLB have not been sufficiently described. Objective: To clarify and describe the psychotic features of prodromal DLB before overt cognitive impairment. Methods: The authors analyzed the characteristic psychotic features of prodromal DLB in 21 subjects who developed severe psychotic symptoms without dementia and were diagnosed as DLB after the longitudinal observation period. They were then confirmed to have DLB through indicative and supportive biomarkers of scintigraphy. Results: The psychotic features included a wide variety of symptoms, but convergent to three principal categories: catatonia, delusions-hallucinations, and depression and/or mania. Catatonia was observed in nine cases, five were delusiona...
Dear Editor, There are gender differences in the initial symptoms of dementia with Lewy bodies (D... more Dear Editor, There are gender differences in the initial symptoms of dementia with Lewy bodies (DLB) and the symptoms when the diagnosis is confirmed, with females having been found to frequently exhibit more psychotic symptoms such as visual/auditory hallucinations, delusions, and depression compared to males. Meanwhile, the frequency of rapid eye movement sleep behaviour disorder is significantly higher in males. Fujishiro et al. sent a letter to us, offering an overview of the possibility that gender differences in incidence of DLB may affect these results, and they included a review of the literature, such as clinical and pathology reports, highlighting that consensus has not been reached regarding the gender differences in DLB incidence. It is easy to assume DLB if visual hallucinations are observed as a psychotic symptom at the onset of DLB, but if the initial symptoms of DLB are other psychotic symptoms such as auditory hallucinations, depression, or delusions, the patient may be more readily diagnosed with other psychotic disorders such as late onset schizophrenia (LOS), senile delusions, and senile depression, rather than DLB. DLB has hypersensitivity to antipsychotic medicines, and drug therapy may have a risk of side effects in some cases. The results of our study indicated that the frequency of auditory hallucinations as the initial symptoms and at the time of diagnosis is higher in females than in males, which is consistent with that of the Tsunoda study. The International Late Onset Schizophrenia Group has taken the unified view that very late onset schizophrenia-like psychosis (VLOSLP), which develops after age 60, predominantly affects females and is mainly characterised by hallucinatory-delusional state or delusional states. It is possible that DLB has some involvement in VLOSLP because the pathological reports related to LOS or VLOSLP actually included DLB cases. In addition, depression has a high prevalence among middle-aged and elderly women, and depressive symptoms frequently appear in the prodromal stage of DLB. Accordingly, careful observation is necessary to distinguish this condition from DLB. There have been numerous research reports published in recent years concerning the prodromal stage of DLB. It has become clear that psychotic symptoms such as visual hallucinations, auditory hallucinations, delusions, and depression appear in conjunction with the prodromal stage of DLB. The presentation of various psychotic symptoms prior to the appearance of neurological findings and cognitive impairment in DLB cases is thought to be due in part to the diversity of the patterns of Lewy body development. The DLB pathology report published by Fujimi et al. states that the neocortical type was significantly more common in females (54.0%) than in males (18.1%), which could explain why females exhibit more psychotic symptoms than males. The existence of gender differences in symptom incidence of DLB, including the stage of prodromal DLB, is certainly an important aspect to consider in order to ensure accurate clinical diagnoses of DLB and to promote understanding of the pathophysiology of the prodromal stage in the future.
Although dementia with Lewy bodies (DLB) is characterized by a variety of initial symptoms, there... more Although dementia with Lewy bodies (DLB) is characterized by a variety of initial symptoms, there are almost no reports of the initial symptoms of DLB assessed in a large number of cases. We retrospectively evaluated the initial symptoms of 234 participants with DLB and DLB‐related symptoms at diagnosis and characterized any gender differences in the symptom profiles.
In Alzheimer’s disease, apart from inscription memory deficit, other high order brain function de... more In Alzheimer’s disease, apart from inscription memory deficit, other high order brain function deficits also appear in the early stage, such as geographical orientation deficit, visual cognition deficit, and organization deficit. These neuropsychological symptoms are rarely seen in other dementiform diseases and are considered to be characteristic of Alzheimer’s disease(AD).4 Among these, organization deficit including constructional disability almost inevitably occur in AD. As this deficit is considered to be closely related to the visual space cognition deficit, we analyzed the visual information processing mechanism for the execution of organization, using newly developed methods such as a vision analyzer.1 The results showed a characteristic fixation movement in AD patients. A concentration of fixation points on the right hand side, and concentration and deviation of the fixation points when the patients observed copied and original figures, were frequently seen, when the patient was copying a geometrical figure.
Neurofibrillary tangles (NFT) are one of the most prominent pathological changes seen in the brai... more Neurofibrillary tangles (NFT) are one of the most prominent pathological changes seen in the brains of Alzheimer’s disease (Alz) patients. Under the electron microscope these NFT are revealed to be composed of accumulations of paired helical filaments (PHF). These structures are also observed in Parkinsonism-dementia complex of Guam (PD), and some other diseases besides Alz.
Amyloid deposits occur in the forms of senile plaques (SP’s), amyloid angiopathy(AA), and plaque-... more Amyloid deposits occur in the forms of senile plaques (SP’s), amyloid angiopathy(AA), and plaque-like vascular changes in the brains of Alzheimer’s disease (Alz) patients. These pathological changes are important since the occurrence of these structures is correlated with the severity of the dementia. A protein consisting of 42–43 amino acids and with a molecular weight of about 4000 kd, designated as amyloid A41 or β-protein,2 has been isolated as a component of amyloid protein (Am) from AA in the Alz brain. The same A4 protein as in AA is also found commonly in various types of SP’s in Alz and Down’s syndrome.
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Papers by Ryo Fukatsu